It is estimated that there will be 140,430 new diagnoses of urogenital cancers and 30,000 associated deaths in 2013. Metastatic progression is the primary cause of cancer-related death. Managing care for cancer patients with progressive disease is an arduous challenge and poses an increasing financial burden on our medical institutions. Therefore, is imperative that we elucidate the molecular mechanisms that drive metastasis and identify clinical biomarkers that can specifically recognize invasive disease and rapidly assess therapeutic response. Fluid-based biomarkers are ideal for disease surveillance and therapeutic monitoring because they allow for non-invasive, repetitive sampling. The clinical impact of such a biomarker would be multifaceted by reducing healthcare costs, reducing toxicities associated with ineffective drugs, and improving the implementation of drug trials. In summary, successful implementation of active monitoring for recurrence and rapid identification of treatment response is synonymous with reducing morbidity, mortality, and the associated health care cost.